Organization
SHORE ROAD RADIOLOGY ASSOCIATES, PC
Active
Organization
SHORE ROAD RADIOLOGY ASSOCIATES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY DELLACERRA V.P. (VP MANAGED CARE & REVENUE COMPLIANC)
(718) 630-7103
Entity
Organization
Contact information
Practice address
150 55TH ST, BROOKLYN, NY 11220-2559
(718) 630-7477
(718) 630-7437
Mailing address
5800 3RD AVE, LUTHERAN MEDICAL CENTER-MANAGED CARE DEPARTMENT, BROOKLYN, NY 11220-3702
(718) 630-7477
(718) 630-7437
Taxonomy
Speciality
Code
Description
License number
State
2085N0904X
Nuclear Radiology Physician
16820
NY
2085R0202X
Diagnostic Radiology Physician
Primary
16820
NY
2085R0204X
Vascular & Interventional Radiology Physician
16820
NY
2085U0001X
Diagnostic Ultrasound Physician
16820
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00809412
—
NY
Enumeration date
08/01/2006
Last updated
09/08/2008
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